Pathology/Lab Coding Alert

With or without urinary obstruction? That is the question. To assign the correct diagnosis code for a benign prostate biopsy, pathologists will need to know the answer. The annual ICD9 Codes, effective Oct. 1, changes prostate hyperplasia codes by adding a fifth digit to indicate the presence or absence of urinary obstruction. "You'll need to know the ordering physician's findings, including the patient's urinary obstruction status, to provide a payable diagnosis for an abnormal benign prostate biopsy," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. New Five-Digit Codes Required The 2004 ICD-9 invalidates four subcategory (four-digit) codes in the 600 category and replaces them with eight subclassification (five-digit) codes. You should no longer report the deleted four-digit codes, but instead report the replacement five-digit codes shown in the table. Pathologist Reports Confirmed Diagnosis When filing for Medicare Part B pathology services, you must report the ICD-9 code(s) that most accurately describe the pathologist's diagnosis. For example, the physician may order a prostate biopsy based on an elevated prostate specific antigen (PSA) test (790.93 - Elevated prostate specific antigen). But if the pathologist makes a biopsy diagnosis of prostate fibroadenoma, you should report the ICD-9 code for that condition. Because you must report the new codes to the fifth digit, you have to use either 600.20 (... without urinary obstruction) or 600.21 (... with urinary obstruction). Using any of the new 600-series codes requires that you know whether the patient has a urinary obstruction. "We routinely request the patient's clinical history, so we should have that information along with the pathologist's findings when assigning the diagnosis code," Slagle says. How can you ensure that you have all the information you need to assign the correct codes? "Physician education is the best tool you have," says R.M. Stainton, MD, president of Doctor's Anatomic Pathology in Jonesboro, Ark. "Make sure your clients know that you need clinical information when they submit a prostate biopsy, such as whether the patient has urinary obstruction [599.6, Urinary obstruction, unspecified] or urinary retention [788.20, Urinary retention, unspecified]."